Treatment, Monitoring, and Management of Patients With Relapsed/Refractory Chronic Lymphocytic Leukemia and Mantle Cell Lymphoma: Evidence From a Multi-Country Needs Assessment.

BACKGROUND: The treatment landscape for relapse/refractory chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL) has evolved with recent novel agents. With the availability of novel agents that slow disease progression, managing treatment side effects and monitoring response in patients with these hematologic malignancies may present a challenge for healthcare providers. The imperative to engage patients in the management of their condition demands that specialists are knowledgeable about new treatment options and are skilled and confident in educating patients to manage and monitor for potential side effects. AIMS: This study aimed to establish the current knowledge, skills and confidence levels of oncologists, hematologists and hematologist-oncologists (ONC/HEM) and identify the challenges they experience when managing and monitoring treatment and engaging patients with CLL or MCL in shared decision-making. The long-term aim is to inform evidence-based continuing medical education to optimize ONC/HEM competencies. METHODS AND RESULTS: This cross-sectional study employed a quantitative survey, completed by 285 ONC/HEM practicing in academic or community settings in Brazil, France, Germany, the United Kingdom, and the United States. Using 5-point Likert-type scales, participants reported their knowledge/skills/confidence levels, and their agreement with selected statements. Sub-optimal levels of knowledge/skills to identify and manage side effects associated with treatments for CLL or MCL were reported. Challenges with patient risk stratification and engaging patients in shared decision-making were reported, with a greater proportion reported by those in community settings. Of note, 31% of participants reported sub-optimal skills identifying patients at higher risk for progression and using stratification to plan and manage treatment, and 58% never/rarely/sometimes considered patients' concerns about treatment safety. CONCLUSION: Continuing medical education activities to improve knowledge of new treatments and associated pathways for patients with CLL or MCL, and to develop skills/confidence to engage in shared decision-making are recommended. Setting-specific issues should be integrated into interventions to ensure relevant educational support for the ONC/HEM.